克拉霉素、甲硝唑和兰索拉唑联合治疗幽门螺杆菌感染的临床疗效观察

目的：本文报道克拉霉素与甲硝唑及兰索拉唑联合应用治疗ＨＰ阳性的十二指肠溃疡。方法：５９例符合条件的病人随机分成两个治疗组，其中３０例口服充拉霉素２５０ｍｇ，甲硝唑４００ｍｇ，兰索拉唑３０ｍｇ。另一组２９例口服克拉霉素５００ｍｇ，甲硝唑４００ｍｇ．兰索拉唑３０ｍｇ，用法均为每日２次，疗程１周，继而口服兰索拉唑３０ｍｇ，每日１次，共１周。疗程结束后１个月复查胃镜。结果：克拉霉素１０００ｍｇ组ＨＰ根除率及溃疡愈合率分别为９３．１％及８９．７％，稍高于克拉霉素５００ｍｇ组的７６．７％及８０．０％，但差异无显著性（Ｐ＞０．０５）。体外检测。克拉霉素ＨＰ耐药发生率仅４．８％，而甲硝唑ＨＰ耐药发生率则达３３．３％，且甲硝唑耐药对ＨＰ根除率有较大影响。两组病人副反应总发生率为１５．３％，克拉霉素两个剂量组间副反应发生率无明显差别，未发现严重副反应。病人依从性良好。结论：克拉霉素与甲硝唑及兰索拉唑合用１周疗法有较理想的溃疡愈合率与ＨＰ根除率；克拉霉素用量以每日１０００ｍｇ为佳。

Clinical study of one week clarithromycin combination therapy for the treatment of H. pylori infection

Objectives: The efficacy of one week clarythromycin combination therapy in optimal dosage for the treatment of H. pylori infection was studied, and the influence of resistance to antibiotics on the eradication rate was also investigated. Methods: Fifty-nine patients with positive H. pylori active duodenal ulcer were recruited, H. pylori status was determinated by urease test, culture and histology before treatment and four weeks after cessation of all treatment, and resistance of H. pylori to clarithromycin and metronidazole was also tested. Patients were randomised into two groups: Group A received lanaoprazole 30mg, metronidazole 400mg and clarithromycin 250mg, each twice daily, and Group B lansoprazole 30mg combined with metronidazole 400mg and clarithromycin 500mg each twice daily. Combination therapy was administered for one week followed by lactsoprazole alone for a week further. Results: (1) Eradication rates of H. pylori were 76.7% (23/30) and 93.1% (27/28) in Group A and Group B, respectively (P>0.05); (2) Ulcer healing rates were 80.0% and 88.7 % in Group A and Group B, respectively (P>0.05): (3) Total side effect in 49 patients was 15.3%,all were mild and no statistical difference between the two groups; (4) Clarythromycin resistance . only accounted for 4.8 % whereas metronidazole resistance was 33.3% and eradication rate was much lower in patients with metronidazole resistance, Conclusions: clarithromycin combined with lansoprazole and metronida- zole for one week was highly effective in the cure of H. pylori and 500mg clarithromycin twice daily gave even better result.